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Biomedical subjects

V Descamps

Publications and source records attributed to V Descamps.

101 records · Page 6Linked to original sources
PubMed1993

Cryoglobulinemia with vasculitis associated with hepatitis C virus infection.

Essential mixed cryoglobulinemia is frequently associated with chronic hepatitis. This report presents four cases of cryoglobulinemia with vasculitis associated with chronic hepatitis related to hepatitis C virus infection. Hepatitis C virus infection was ascertained in the four patients by both the presence in the serum of anti-HCV antibodies detected by the four-antigen recombinant immunoblot assay and of HCV RNA detected by polymerase chain reaction. In two patients tested, anti-HCV antibodies were not detected after centrifugation in the purified cryoglobulin but were detected in the supernatant. HCV RNA was detected in the purified cryoglobulin in all four patients and was detected in the supernatant in three patients. In one patient receiving recombinant interferon alfa, serum aminotransferases normalized and cryoglobulin disappeared; in another patient receiving recombinant interferon alfa, serum aminotransferases remained high and the cryoglobulin persisted. The presence of HCV RNA in the cryoglobulin and the parallelism of the changes of the cryoglobulinemia and of the serum aminotransferases during recombinant interferon alfa administration suggest that HCV infection is responsible for the production of cryoglobulinemia and vasculitis. It is proposed that HCV infection is a cause of cryoglobulinemia associated with chronic hepatitis.

Adult↗
PubMedDate not supplied

[Efalizumab].

Efalizumab (Raptiva, Serono) is a humanised monoclonal antibody (IgG1) produced by biotechnology. This antibody has a novel place among biotherapies for psoriasis. It is bound to the CD11a subunit of a surface molecule of the T lymphocyte LFA-1 (Leucocyte Function-associated Antigen-1). This molecule is essential for binding of T lymphocytes to the ICAM-1 molecule (Intercellular Adhesion Molecule-1) found on antigen-presenting cells, endothelial cells and keratinocytes. Binding of efalizumab to CD11a prevents binding of LFA-1 to ICAM-1, thus inhibiting several steps in the immunological process responsible for formation of psoriatic plaque (activation of naive T lymphocytes to memory T lymphocytes, lymphocyte migration and reactivation of T lymphocytes in skin). Efalizumab was approved in the United States by the FDA (Food and Drug Administration) in 2003 for the treatment of moderate-to-severe psoriasis requiring systemic therapy. It may be used as first-line therapy in the United States in this indication. In France, marketing authorisation (MA) was granted more recently in September 2005. The indications are moderate-to-severe cutaneous plaque psoriasis in adults in cases of failure, intolerance or contraindication of at least two systemic treatments including phototherapy, methotrexate and cyclosporine. Current clinical trial data is available for 3500 patients with plaque psoriasis. A 75% improvement in PASI score was seen in between 22 and 39% of patients treated with efalizumab (vs. 2 to 5% for patients on placebo) in a single weekly subcutaneous injection (1 mg/kg). A study in good responders confirms the continuing long-term efficacy of prescription of the drug up to 36 months (with at least a 75% improvement in PASI score in 53% of patients). However, it is not effective against joint involvement in psoriasis. The most common side-effects (incidence >1/100) are influenza-like syndrome, risk of outbreak of cutaneous psoriasis during or after discontinuation of treatment, worsening of arthralgia, minor hypersensitivity reactions, reversible changes in laboratory values (hyperlymphocytosis, elevated alkaline phosphatases and transaminases). Because of rare cases of thrombocytopenia (incidence<1/100), reversible on discontinuation of treatment, monthly monitoring of platelet counts is required over the first 3 months of therapy. There are currently no randomised studies comparing the various systemic treatments (standard therapy and biotherapy) for psoriasis. However, on extrapolation of the available results concerning efficacy (PASI-75 after 12 weeks of treatment), efalizumab appears to be less efficacious than anti-TNF alpha agents. This drug constitutes an additional treatment option and its position in the therapeutic arsenal will depend upon its long-term benefit/risk ratio in relation to other biotherapies.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Kimura's disease associated with extracapillary glomerulonephritis].

BACKGROUND: Kimura's disease is a rare and benign chronic inflammatory soft-tissue disorder of unknown origin. Most cases involve young Asian males. The typical presentation consists of painless papules or nodules with a predilection for the head and neck region, associated with lymphadenopathy, parotid gland involvement, peripheral blood eosinophilia and raised immunoglobulin E. PATIENTS AND METHODS: A 49-year-old Mauritian man was hospitalized for nephrotic syndrome. Examination revealed a painless 3 cm nodule in the left pre-auricular region and multiple enlarged left cervical lymph nodes. Histopathologic examination of a nodule confirmed the diagnosis of Kimura's disease, which was associated with necrotic extracapillary glomerulonephritis. Corticosteroids were initiated, resulting in rapid improvement of renal function and partial regression of the patient's cutaneous nodules and lymph node disorder. DISCUSSION: Renal manifestations are the only visceral localization of Kimura's disease, and proteinuria is seen in 12% of cases, of which 50% are accompanied by nephrotic syndrome. Many different histologic types of renal involvement may be observed with potentially severe lesions. To our knowledge, this is the first case of Kimura's disease associated with extracapillary glomerulonephritis.

Angiolymphoid Hyperplasia with Eosinophilia↗
PubMedDate not supplied

Bullous pemphigoid in a leg affected with hemiparesia: a possible relation of neurological diseases with bullous pemphigoid?

We report a typical case of bullous pemphigoid (BP) associated with a neurological disorder and study a possible link between neurological disorders and BP. An 84-year-old hemiplegic woman presented with unilateral BP on the hemiparetic side. BP was confirmed by histological and immunofluorescence data. The medical records of the previous 46 consecutive patients with BP were retrospectively analyzed (average age: 79; median age: 85). Thirty of the 46 patients with BP had neurological disorders. These disorders included dementia, epilepsy, multiple sclerosis, cerebral stroke, Parkinson's disease, gonadotropic adenoma, trembling, dyskinesia, lumbar spinal stenosis. In a control group of the 46 consecutive oldest patients (older than 71; average age: 82,5; median age: 80) with another skin disease referred during the previous two-year-period to our one-day-unit only, 13 patients had a neurological disorder. This study demonstrates that there is a high prevalence of neurological disorders in patients with BP (p = 0.0004). A prospective case control study with neurological examination and psychometrical evaluation is warranted to confirm these data. We speculate that neuroautoimmunity associated with the aging process or neurological disorders may be involved in pemphigoid development via an autoimmune response against dystonin which shares homology with bullous pemphigoid antigen 1. Bullous pemphigoid could be considered to be a marker of neurological disorder.

Adolescent↗
PubMedDate not supplied

[Management of external genital warts by dermatologists: a French survey].

BACKGROUND: External genital wart is the most frequent sexually transmitted disease. While there are guidelines for management and treatment, no data about primary care of this viral disease is available in France. So, we conducted a survey on French dermatologists'management of external genital warts. METHODS: In July and August 2001, a questionnaire - including questions on physicians and patients, sexually transmitted diseases, partners, clinical and viral evaluations, treatments, and follow-up - was mailed to 652 French dermatologists (randomization of 20 p. 100 of French dermatologists). RESULTS: Three hundred and fifty (53 p. 100) responses were returned. Dermatologists were mainly exclusively office practitioners (58 p. 100). Thirty-six percent of them were taking care of more than 3 patients per month with external genital warts. Patients were essentially men and immunocompetent. Only 52 p. 100 of physicians systematically performed a sexually transmitted disease evaluation, 38 p. 100 a partner evaluation, and 17 p. 100 a local evaluation for external genital warts. Biopsy was occasionally performed by 48 p. 100 of physicians, mainly in order to confirm diagnosis. Viral genotyping was rare. Cryotherapy (84 to 93 p. 100) and podophyllotoxin (40 to 55 p. 100) were the two treatments used as first line therapy, while laser (61 to 71 p. 100), and imiquimod (39 to 48 p. 100) were second line therapies. Sixty-three percent of physicians proposed a systematic clinical control after clinical recovery. CONCLUSION: This large survey represents an overview on general practice concerning external genital warts among French dermatologists. Our study points out the lack of global management (loco-regional, partner, and STD evaluation) of the disease by dermatologists.

Adjuvants, Immunologic↗
PubMedDate not supplied

[External anogenital condylomas].

External anogenital condylomas are the clinical expression of a human papillomavirus mucosal infection. However, only a small proportion of patients infected by this virus will express the disease. Nevertheless, this dermatitis remains one of the most prevalent of sexually transmitted diseases and poses problems in its management. These problems are centered on phenomena of viral latency, which do not permit one to guarantee the cure of the patient, and the absence of specific anti-viral treatment. This article proposes to review the status of external anogenital condylomas. Inspired by recently published experts' recommendations, it emphasizes the problems encountered in daily practice by proposing coherent practical approaches: better understanding of the disease and contamination, assessment of the lesions, the problems related to immunodepression, the psychological approach and current therapeutic possibilities.

Adjuvants, Immunologic↗